STATE OF CALIFORNIA SINGLE DWELLING UNIT HOT WATER SYSTEM DISTRIBUTION - STORAGE CEC-CF2R-PLB-02-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION Single Dwelling Unit Hot Water System Distribution CF2R PLB 02 E (Page 1 of 2) Project Name: Enforcement Agency: Permit Number: Dwelling Address: City Zip Code VENTURA A. General Information 01 Dwelling Unit Name SINGLE FAMILY DWELLING B. Design Dwelling Unit Water Heating Systems Information This table reports the water heating system features that were specified on the registered CF1R compliance document for this project. 01 02 03 04 05 06 07 08 09 10 11 12 Water Heating System ID or Name Water Heating System Type Water Heater Type DOMESTIC STORAGE # of Water Heaters in system Water Heater Storage Volume (gal) ONE Rated Input Type Fuel Type GAS Rated Input Value BTU/HR ≤75,000 Heating Efficiency Type EF Heating Efficiency Value ≥ .58 13 14 Standby Loss (%) Exterior Insul. R Value Central DHW System Distribution Type Dwelling Unit DHW System Distribution Type N/A N/A N/A PARALLEL C. Installed Dwelling Unit Water Heating Systems Information 01 Water Heating System ID or Name 02 Water Heating System Type 03 04 05 06 07 08 09 10 11 12 13 14 Water Heater Type # of Water Heaters in system Water Heater Storage Volume (gal) Fuel Type Rated Input Type Rated Input Value Heating Efficiency Type Heating Efficiency Value Standby Loss (%) Exterior Insul. R Value Central DHW System Distribution Type Dwelling Unit DHW System Distribution Type DOMESTIC STORAGE ONE GAS BTU/HR EF N/A N/A N/A PARALLEL D. Installed Water Heater Manufacturer Information 01 02 03 Water Heating System ID or Name Manufacturer Model Number CA Building Energy Efficiency Standards 2013 Residential Compliance June 2014 STATE OF CALIFORNIA SINGLE DWELLING UNIT HOT WATER SYSTEM DISTRIBUTION CEC-CF2R-PLB-02-E (Revised 06/14) CALIFORNIA ENERGY COMMISSION CERTIFICATE OF INSTALLATION Single Dwelling Unit Hot Water System Distribution CF2R PLB 02 E (Page 2 of 2) Project Name: Enforcement Agency: Permit Number: Dwelling Address: City Zip Code VENTURA DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Installation documentation is accurate and complete. Documentation Author Name: Documentation Author Signature: Documentation Author Company Name: Date Signed: Address: CEA/HERS Certification Identification (If applicable): City/State/Zip: Phone: RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California: 1. 2. The information provided on this Certificate of Installation is true and correct. 3. The constructed or installed features, materials, components or manufactured devices (the installation) identified on this Certificate of Installation conforms to all applicable codes and regulations, and the installation conforms to the requirements given on the plans and specifications approved by the enforcement agency. I reviewed a copy of the Certificate of Compliance approved by the enforcement agency that identifies the specific requirements for the scope of construction or installation identified on this Certificate of Installation, and I have ensured that the requirements that apply to the construction or installation have been met. I will ensure that a registered copy of this Certificate of Installation shall be posted, or made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Installation is required to be included with the documentation the builder provides to the building owner at occupancy. 4. 5. I am eligible under Division 3 of the Business and Professions Code in the applicable classification to accept responsibility for the system design, construction, or installation of features, materials, components, or manufactured devices for the scope of work identified on this Certificate of Installation, and attest to the declarations in this statement (responsible builder/installer), otherwise I am an authorized representative of the responsible builder/installer. Responsible Builder/Installer Name: Responsible Builder/Installer Signature: Company Name: (Installing Subcontractor or General Contractor or Builder/Owner) Position With Company (Title): Address: CSLB License: City/State/Zip: Phone CA Building Energy Efficiency Standards 2013 Residential Compliance Date Signed: June 2014